Provider Demographics
NPI:1053503243
Name:CHEYENNE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:CHEYENNE CHIROPRACTIC, P.C.
Other - Org Name:HALL CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-246-3904
Mailing Address - Street 1:2541 S I H 35
Mailing Address - Street 2:SUITE #400
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7360
Mailing Address - Country:US
Mailing Address - Phone:512-246-3904
Mailing Address - Fax:512-246-2391
Practice Address - Street 1:2541 S I H 35
Practice Address - Street 2:SUITE #400
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7360
Practice Address - Country:US
Practice Address - Phone:512-246-3904
Practice Address - Fax:512-246-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY41803Medicare UPIN